Healthcare Provider Details

I. General information

NPI: 1972378859
Provider Name (Legal Business Name): HEATHER HOLZHAUSER, LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 EAST QUINCY STREET UNIT 1E
RIVERSIDE IL
60546
US

IV. Provider business mailing address

54 EAST QUINCY STREET UNIT 1E
RIVERSIDE IL
60546
US

V. Phone/Fax

Practice location:
  • Phone: 708-628-7345
  • Fax:
Mailing address:
  • Phone: 708-628-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HEATHER RENEE HOLZHAUSER
Title or Position: LCSW
Credential:
Phone: 708-628-7345